Only one way to cure mahjong epilepsy - avoid the game
Three mahjong players went into epileptic fits in the first documented cases of so-called 'mahjong epilepsy' in Hong Kong - but it is not because of the frenetic movement of the tiles, a medical journal has reported.
The only cure for those susceptible might be to avoid the game, Queen Mary Hospital doctors wrote in the latest issue of the Hong Kong Medical Journal.
Only 20 other cases of mahjong epilepsy have been reported in medical literature - all of them Taiwanese.
The doctors, led by Windsor Mak Wai-wo, say the stressful game and sleep deprivation might lower the seizure threshold among susceptible players.
'Playing mahjong is associated with considerable stress, especially when monetary bets are involved,' they say in the article.
But they believe mahjong epilepsy is a 'genuine phenomenon and a unique syndrome' because most of the patients had no seizures other than those associated with mahjong.
The doctors present three case reports:
A 79-year-old man who had been playing mahjong for eight hours and was holding 'a ready hand' had a seizure in 1999.
He had experienced two similar seizures before, the first while shuffling the tiles and the second a year later during a mahjong game.
A regular mahjong player who had been playing the game since he was 20 had his first seizure during a round in 1996, when he was 42.
Soon after his discharge, he had a second seizure while playing mahjong.
He subsequently stopped playing for three years, but took it up again for three years before suffering two more attacks, both triggered when playing mahjong.
A 39-year-old occasional mahjong player suffered two attacks. The second attack occurred last year after two hours of mahjong.
The doctors said mahjong epilepsy might also be culture-specific. Epilepsy has been reported among westerners after they play chess and card games, among Japanese while playing soroban, and among Sri Lankans who play punchi, the doctors write.
The epilepsy is triggered in the same way as in other 'reflex epilepsy' because mahjong provokes thinking, spatial tasks and manual tasks that interact in a complex way, they say.
Experts have cited mahjong as a good way for the elderly to work their minds to avoid Alzheimer's disease.
The doctors say that in the Taiwanese cases, treatment was effective in only nine out of 17 patients.
They contend that avoidance of the game may be 'the best means of achieving seizure control'.
The good news is that mahjong epilepsy can be overcome - if the patients stop playing and watching mahjong, they say.